<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200840
Report Date: 11/10/2022
Date Signed: 11/10/2022 01:15:42 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 11/10/2022 01:15 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:BELLA AMORE, INC.FACILITY NUMBER:
019200840
ADMINISTRATOR:SALUTA, CHRISTOPHERFACILITY TYPE:
740
ADDRESS:4904 ADAGIO CTTELEPHONE:
(408) 421-3461
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY:6CENSUS: 0DATE:
11/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Licensee, Chris SalutaTIME COMPLETED:
01:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 11/10/2022 at 1:00 PM, Licensing Program Analysts (LPA) L. Fici arrived to conduct a facility closure inspection. LPA met and was greeted by Licensee, Chris Salute

LPA toured entire facility with Licensee including kitchen, bathrooms, bedrooms, common areas, backyard. LPA confirmed all residents have moved out. Last resident moved out last November 1, 2022.

No deficiency cited on this date.

Licensee surrendered the license during the closure visit. A forfeiture letter will be mailed to licensee at a later time.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Liridon FiciTELEPHONE: (510) 359-0768
LICENSING EVALUATOR SIGNATURE:
DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/10/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1